Good Health As We Age: Perspectives on Substance Use and Aging

At an iPoliticsLive event in Calgary on Monday afternoon, subject-matter experts discussed the upcoming health issues that are unique to the senior population. By 2036, one quarter of the Canadian population will be over the age of 65, and as this population segment grows, issues related to substance abuse are expected to become more prevalent. Older Canadians taking various medications along with alcohol or other substances are facing particular dangers related to addiction.

“Older adults often don’t come to mind when we talk about substance use,” said Dr. Alastair Flint, vice-chair of research in the Department of Psychology at the University of Toronto.

Flint said that the epidemiology in Canada, following a number of studies on the prevalence of substance use, the two most non-prescribed substances are alcohol and tobacco.

“When one is dependent on those things or generally abuses them, generally it’s from a younger age,” said Flint. “A lot of older people who are known to be misusing these or are addicted to them, in fact have often been using them for decades. As you come to old age, you are often talking about the physical health consequences and the functional consequences of these things.”

Flint said the other major area where older people differ from younger counterparts are with the use of prescription drugs, and the fact that they are prescribed by doctors, they don’t consider them to be a problem, while not necessarily paying attention to complications that some of those prescriptions may be causing, which points to a greater need for non-medicinal psychosocial interventions.

Dr. Tony George, chief of the addictions division at the Centre for Addiction and Mental Health (CAMH), says that they are starting to see a greater number of seniors presenting with problematic substance use for the first time.

“It’s a reminder to me that we actually, in the addictions field, have pretty good treatments – both behavioural treatments, and medication treatments, as even some other promising treatments like brain stimulation and even computerized treatments,” said George. “It’s well-known that only about 10 to 15 percent of people with a substance use disorder in general can access treatment, and we know that disparity is there in older adults as well.”

George added that as people get older, they see increasing problems of mental health like depression, anxiety, psychosis or even dementia, which are associated with the increase of substance use, meaning that clinicians need to do a proper, comprehensive assessment to see what is making these people vulnerable.

Rapid changes in people’s life circumstances as they age, much like with young adults, which touch on both physical and social changes, which may also impact on their particular unique needs.

“There’s a lot we don’t know, but there’s a lot we do know,” said Dr. Franco J. Vaccarino, president and vice-chancellor of the University of Guelph. “We have considerable knowledge at our disposal, and it becomes particularly paramount on all of us to make sure that we bring that knowledge to bear on our approaches to care.”

Vaccarino said that this means things like having guidelines for prevention, for treatment and for recovery that reflect the knowledge of the day as it applies to older adults, as well as awareness of the issues. That also means updating educational and training programs to bring in older adults.

While Flint noted that sometimes older Canadians aren’t aware of their own substance use problems until they are brought in to treat an injury like a fall, George also noted that addressing things like alcohol use can lead to vast improvements, which is why consistent screenings in acute-care situations are critical.

“Rather than waiting until the emergency room department incident, it’s having the conversation when the person presents in the primary care professional’s office,” said Rita Notarandrea, CEO of the Canadian Centre on Substance Abuse and Addiction. “What I’m talking about is having a conversation about how much drinking is taking place, and doing the screening and brief intervention if required, but going into a harm-reduction.”

Notarandrea said that having those conversations are better when they’re healthy, which means tailoring screening to the population, but also having standards and guidelines of questions to ask, and looking deeper instead of making the assumption that it’s because they’re old.